摘要
目的 探讨肠内营养（EN）开始时间对有创机械通气危重患者胃液pH值及呼吸机相关性肺炎（VAP）发生的影响,为临床合理选择EN时机提供参考.方法 选择2016年1月1日至2017年11月30日郑州大学第一附属医院重症医学科（ICU）收治的进行EN治疗的机械通气患者,纳入年龄≥18岁、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）≤15分、营养筛查量表（NRS 2002）评分≥3分者.按照EN开始时间将患者分为早期EN组（机械通气开始48 h内实施EN）和晚期EN组（机械通气开始48 h后实施EN）.收集两组患者EN开始后7 d内的胃液pH值、VAP发生情况、机械通气时间和ICU住院时间.结果 共纳入108例患者,早期EN组和晚期EN组各54例.早期EN组胃液pH值低于晚期EN组〔4.8（3.8,5.8）比5.6（4.6,6.6）,P〈0.01〕.早期EN组有8例患者发生VAP,其中3例为早发性VAP;晚期EN组有17例患者发生VAP,其中10例为早发性VAP;早期EN组VAP发生率和早发性VAP发生率均明显低于晚期EN组（14.8％比31.5％,5.6％比18.5％,均P〈0.05）.早期EN组机械通气时间〔d：7.5（5.7,9.0）比8.6（6.8,10.7）〕 和ICU住院时间〔d：10.0（8.5,11.7）比11.0（9.5,12.6）〕均明显短于晚期EN组（均P〈0.05）.结论 早期EN在保护胃黏膜的同时,有助于降低VAP发生率,减少机械通气时间及ICU住院时间,改善预后.
Objective To investigate the effect of enteral nutrition （EN） start time on pH value of gastric juice and ventilator-associated pneumonia （VAP） in critically ill patients with invasive mechanical ventilation, so as to provide reference for the rational selection of EN timing.Methods Patients with mechanical ventilation who underwent EN treatment admitted to the intensive care unit （ICU） of the First Affiliated Hospital of Zhengzhou University from January 1st, 2016 to November 30th, 2017 were enrolled, and the inclusion criteria were age ≥ 18 years, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） ≤ 15, and nutritional risk screening （NRS 2002） ≥ 3. Patients were divided into two groups according to the start time of EN： early EN group （implementation of EN within 48 hours after mechanical ventilation） and late EN group （implementation of EN after 48 hours after mechanical ventilation）. The pH value of gastric juice, VAP incidence, mechanical ventilation time, and the length of ICU stay were compared between the two groups.Results A total of 108 patients were included, 54 in the early EN group and 54 in the late EN group respectively. The pH value of gastric juice in early EN group was lower than that in late EN group [4.8 （3.8, 5.8） vs. 5.6 （4.6, 6.6）,P 〈 0.01]. There were 8 patients with VAP in the early EN group, 3 of whom were early onset VAP. There were 17 patients with VAP in the late EN group, 10 of whom were early onset VAP. The incidence of VAP and the incidence of premature VAP in the early EN group were significantly lower than those in the late EN group （14.8% vs. 31.5%, 5.6% vs. 18.5%, bothP 〈 0.05）. The mechanical ventilation time [days： 7.5 （5.7, 9.0） vs. 8.6 （6.8, 10.7） and the length of ICU stay [days： 10.0 （8.5, 11.7） vs. 11.0 （9.5, 12.6）] in the early EN group were significantly shorter than those in the late EN group （allP 〈 0.05）.Conclusion At the same time of protecting gastric mucosa, early EN is helpful to reduce the incidence of VAP, reduce the duration of mechanical ventilation and the length of ICU stay, and improve the prognosis.
作者
苏世琼
孙荣青
刘瑞芳
徐子舒
Su Shiqiong;Sun Rongqing;Liu Ruifang;Xu Zishu(Department of Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China（working in the Third People＇s Hospital of Henan Province;Department of lntensive Care Unit,the Third People＇s Hospital of Henan Province,Zhengzhou 450000.Henan.China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2018年第8期768-770,共3页
Chinese Critical Care Medicine
基金
河南省医学科技攻关项目（201304072）
关键词
胃液PH值
肠内营养时机
呼吸机相关性肺炎
危重症患者
pH value of gastric juice
Timing of enteral nutrition
Ventilator-associated pneumonia
Critically ill patient
作者简介
通讯作者：孙荣青，Email：rongqing．sun@126．com
